There has been a longstanding need for a new surgical technique for debridement of wounds, especially burn wounds, which will significantly lessen the trauma and enhance healing. Laser surgery has held the hope for fulfillment of the need but, for two decades, a successful laser technique has eluded the investigators.
Laser beams are used in a variety of surgical procedures. Earlier investigators have undertaken to utilize the laser for ablation of tissue in treating surface lesions of the skin and dermatologists are using such devices today. However, there has been negligible success in treating burn wounds. While there are certain inherent advantages afforded by laser surgery for serious burns, these cannot be availed of unless the time required for the surgical procedure becomes at least comparable to that in the conventional scalpel surgery presently used in serious burn cases and unless the debridement leaves a tissue bed that will take a viable skin graft.
A serious burn on the human body usually extends well below the superficial skin surface. A significant thickness of tissue dies as a result of the thermal assault and this necrotic material develops into a scar mass called eschar. The interface between the eschar and the sublying viable tissue is a fertile anaerobic region for growth and propagation of infection. The current technique for medical treatment involves debridement (i.e., removal) of the eschar by a surgical procedure called "tangential excision", accomplished with a scalpel. After the debridement, the exposed viable tissue is covered with a skin graft which provides protection against fluid loss and contamination and initiates the healing process. This surgical procedure is known to be highly traumatic. Debridement by tangential excision for severe and extensive burn wounds may require many hours for the procedure and there is an attendant very high loss of blood during the debridement. Much effort has been expended by investigators in seeking to develop a laser debridement technique to replace the scalpel excision technique with its attendant trauma.